Provider Demographics
NPI:1952027989
Name:WEATHERS, KAITLYN MASON (FNP)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:MASON
Last Name:WEATHERS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W PINE ST
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29702-1549
Mailing Address - Country:US
Mailing Address - Phone:864-902-5294
Mailing Address - Fax:864-839-9901
Practice Address - Street 1:1610 N LIMESTONE ST
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29340-2312
Practice Address - Country:US
Practice Address - Phone:864-902-5294
Practice Address - Fax:864-839-9901
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC263888363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily